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Risk factors and clinical significance of invasive infections caused by levofloxacin-resistant Streptococcus pneumoniae

机译：耐左氧氟沙星肺炎链球菌引起的侵袭性感染的危险因素和临床意义

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Purpose: Fluoroquinolones are recommended for the treatment of pneumonia. The recognition of risk factors for invasive levofloxacin-resistant Streptococcus pneumoniae is important for the design of treatment. Methods: A retrospective review of cases of invasive pneumococcal infections in adults was undertaken. Epidemiologic data, predisposing factors, clinical variables, and outcome were recorded from previously established protocols. Antimicrobial susceptibility was determined by disk diffusion and the Etest method. Serotyping was performed by latex agglutination and Quellung reaction. Results: Twenty patients with infection caused by levofloxacin-resistant pneumococci [minimum inhibitory concentration (MIC) ≥2 μg/ml] were compared with 102 patients harboring levofloxacin-susceptible strains; 80 % of levofloxacin-resistant pneumococci were resistant to ≥3 antibiotics but susceptible to penicillin. Most levofloxacin-resistant strains (80 %) belonged to serotype 8. In comparison, only 8 % of levofloxacin-susceptible pneumococci belonged to serotype 8. In the multivariate analysis, residence in public shelters [odds ratio (OR) 26.13; p 0.002], previous hospitalization (OR 61.77; p < 0.001), human immunodeficiency virus (HIV) infection (OR 28.14; p = 0.009), and heavy smoking (OR 14.41; p = 0.016) were associated with an increased risk of infection by levofloxacin-resistant pneumococci. Mortality caused by levofloxacin-resistant and levofloxacin-susceptible pneumococci was 35 and 14 %, respectively. Among HIV-positive individuals infected with levofloxacin- resistant pneumococci 44 % died, but only 12.5 % of HIV-positive patients with levofloxacin-susceptible strains died. Conclusions: We observed the emergence of serotype 8 as the main cause of invasive disease caused by levofloxacin- resistant S. pneumoniae. HIV-positive patients seem to be prone to infection caused by multidrug-resistant serotype 8 and have a high mortality rate.
机译：目的：推荐使用氟喹诺酮类药物治疗肺炎。对侵入性耐左氧氟沙星的肺炎链球菌的危险因素的认识对于治疗的设计很重要。方法：回顾性分析成人侵袭性肺炎球菌感染病例。流行病学数据，诱发因素，临床变量和结局均从先前建立的方案中记录下来。通过盘扩散和Etest方法确定抗微生物药性。通过乳胶凝集和Quellung反应进行血清分型。结果：将20例由耐左氧氟沙星肺炎球菌感染的患者[最低抑菌浓度（MIC）≥2μg/ ml]与102例携带左氧氟沙星敏感菌株的患者进行比较;耐左氧氟沙星的肺炎球菌80％对≥3种抗生素有抗药性，但对青霉素敏感。多数对左氧氟沙星耐药的菌株（80％）属于血清型8。相比之下，对左氧氟沙星敏感的肺炎球菌只有8％属于血清型8。 [p = 0.002]，先前的住院治疗（OR 61.77; p <0.001），人免疫缺陷病毒（HIV）感染（OR 28.14; p = 0.009）和重度吸烟（OR 14.41; p = 0.016）与感染风险增加相关耐左氧氟沙星的肺炎链球菌。耐左氧氟沙星和易感左氧氟沙星的肺炎球菌引起的死亡率分别为35％和14％。在感染了耐左氧氟沙星的肺炎链球菌的HIV阳性患者中，有44％死亡，但只有12.5％的具有左氧氟沙星敏感性的HIV阳性患者死亡。结论：我们观察到血清型8的出现是由耐左氧氟沙星的肺炎链球菌引起的侵袭性疾病的主要原因。 HIV阳性患者似乎容易因多重耐药血清型8引起感染，并且死亡率很高。

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